Human forearm arteriovenous differences of carnitine, short-chain acylcarnitine and long-chain acylcarnitine

1. Forearm arterial and venous concentrations of free carnitine, short-chain acylcarnitine, long-chain acylcarnitine, glucose, lactate, pyruvate, alanine, non-esterified fatty acids, glycerol, 3-hydroxybutyrate and acetoacetate were measured in fasted adult subjects. 2. In all subjects there was net uptake of short-chain acylcarnitine, 3-hydroxybutyrate and acetoacetate and net release of free carnitine and non-esterified fatty acids. The arteriovenous differences of the other metabolites were not consistent. 3. These observations support the concept that short-chain acylcarnitine (largely acetylcarnitine) contributes to the flux of metabolic fuels from the liver to muscle in the fasted state, although to a limited extent in comparison with 3-hydroxybutyrate (less than 5% on a molar basis).     

Free and total carnitine and acylcarnitine content of plasma, urine, liver and muscle of alcoholics

1. Plasma and urine free and total carnitine and acylcarnitine levels were assayed in 12 control subjects and 20 chronic alcoholics with fatty liver. Although the alcoholics had a wider range of values than the controls, there was no significant difference between the two groups. 2. Hepatic free and total carnitine and long- and short-chain acylcarnitines were assayed by a radioenzymatic method in samples from seven control subjects and seven alcoholics. No significant differences in any of the indices were noted between the patient and control groups and it was concluded that carnitine deficiency did not contribute to alcoholic fatty liver in patients without cirrhosis. 3. Skeletal muscle free and total carnitine and long- and short-chain acylcarnitines were assayed in eight alcoholics and seven control subjects. The alcoholics had significantly higher total and free carnitine levels. It is suggested that this reflects a selective enrichment of the biopsy sample with type I carnitine-rich fibres due to the type II fibre atrophy found in approximately half the patients.     

Inhibition of mitochondrial carnitine acylcarnitine translocase by hypoglycaemia-inducing substances

The rate of mitochondrial carnitine-carnitine exchange mediated by carnitine acylcarnitine translocase was measured in the presence of the two hypoglycaemia-inducing drugs, 2-(3-methyl-cinnamyl-hydrazono)-propionate and 2-(3-phenylpropoxyimino)-butyric acid (BM 13.677). Both substances caused a concentration-dependent decrease in the rate of carnitine uptake in guinea pig liver mitochondria. Apparent initial influx rates were decreased by 75% and 80% at a concentration of 2 mmol/l 2-(3-methyl-cinnamyl-hydrazono)-propionate and 2-(3-phenylpropoxyimino)-butyric acid, respectively. Intraperitoneal injections of 212 mumol 2-(3-phenylpropoxyimino)-butyric acid or 21 mumol 2-(3-methyl-cinnamyl-hydrazono)-propionate per kg body weight caused a noticeable decrease in blood glucose concentration. A significant fall of the blood ketone body concentration was achieved with 2-(3-methyl-cinnamyl-hydrazono)-propionate or 2-(3-phenylpropoxyimino)-butyric acid, at dosages of 21 and 255 mumol/l, respectively. Furthermore there was a dose-dependent increase in the plasma free fatty acid concentration in the presence of 2-(3-methyl-cinnamyl-hydrazono)-propionate. This increase, however, was much less pronounced with 2-(3-phenylpropoxyimino)-butyric acid. Metabolic effects of 2-(3-methyl-cinnamyl-hydrazono)-propionate are consistent with an inhibition of long-chain fatty acid transport, whereas an additional mechanism of action has to be assumed for 2-(3-phenylpropoxyimino)-butyric acid.     

Age-related variations in acylcarnitine and free carnitine concentrations measured by tandem mass spectrometry

BACKGROUND: The acylcarnitine profiles obtained from dried blood spots on "Guthrie cards" have been widely used for the diagnosis and follow-up of children suspected of carrying an inherited error of metabolism, but little attention has been paid to potential age-related variations in the reference values. In this study, we evaluated the variations in free carnitine and acylcarnitine concentrations with age, as measured by tandem mass spectrometry. METHODS: Filter-paper blood spots were collected from 433 healthy individuals over a period of 17 months. Eight age groups were defined: cord blood, 3-6 days (control group), 15-55 days, 2-18 months, 19-59 months, 5-10 years, 11-17 years, and 18-54 years. Free carnitine and acylcarnitines were measured for each individual. Mean values were calculated for each age group and compared with those for the control group. RESULTS: Free carnitine was significantly higher in older children than in newborns (P <0.05), but the concentrations of several acylcarnitines tended to be significantly lower in cord blood and in groups of older children than in the control group. Only minor sex-related differences were observed. CONCLUSION: Although the risk of underdiagnosis of fatty acid oxidation disorders with the use of newborn values as reference can be considered as small, in some circumstances the use of age-related reference values may have a potential impact on the diagnosis and management of inherited errors of metabolism.     

Changes in blood carnitine and acylcarnitine profiles of very long-chain acyl-CoA dehydrogenase-deficient mice subjected to stress

BACKGROUND: In humans with deficiency of the very long-chain acyl-CoA dehydrogenase (VLCAD), C14-C18 acylcarnitines accumulate. In this paper we have used the VLCAD knockout mouse as a model to study changes in blood carnitine and acylcarnitine profiles under stress. DESIGN: VLCAD knockout mice exhibit stress-induced hypoglycaemia and skeletal myopathy; symptoms resembling human VLCADD. To study the extent of biochemical derangement in response to different stressors, we determined blood carnitine and acylcarnitine profiles after exercise on a treadmill, fasting, or exposure to cold. RESULTS: Even in a nonstressed, well-fed state, knockout mice presented twofold higher C14-C18 acylcarnitines and a lower free carnitine of 72% as compared to wild-type littermates. After 1 h of intense exercise, the C14-C18 acylcarnitines in blood significantly increased, but free carnitine remained unchanged. After 8 h of fasting at 4 degrees C, the long-chain acylcarnitines were elevated 5-fold in knockout mice in comparison with concentrations in unstressed wild-type mice (P < 0.05), and four out of 12 knockout mice died. Free carnitine decreased to 44% as compared with unstressed wild-type mice. An increase in C14-C18 acylcarnitines and a decrease of free carnitine were also observed in fasted heterozygous and wild-type mice. CONCLUSIONS: Long-chain acylcarnitines in blood increase in knockout mice in response to different stressors and concentrations correlate with the clinical condition. A decrease in blood free carnitine in response to severe stress is observed in knockout mice but also in wild-type littermates. Monitoring blood acylcarnitine profiles in response to different stressors may allow systematic analysis of therapeutic interventions in VLCAD knockout mice.     

Hepatic carnitine palmitoyltransferase I deficiency: acylcarnitine profiles in blood spots are highly specific

BACKGROUND: In carnitine palmitoyltransferase I (CPT-I) deficiency (MIM 255120), free carnitine can be increased with no pathologic acylcarnitine species detectable. As inclusion of CPT-I deficiency in high-risk and newborn screening could prevent potentially life-threatening complications, we tested whether CPT-I deficiency might be diagnosed by electrospray ionization-tandem mass spectrometry (ESI-MS/MS). METHODS: A 3.2-mm spot of whole blood dried on filter paper was extracted with 150 microL of methanol. After derivatization of carnitine and acylcarnitines to their butyl esters, the samples were analyzed by ESI-MS/MS with 37.5 pmol of L-[(2)H(3)]carnitine and 7.5 pmol of L-[(2)H(3)]palmitoylcarnitine as internal standards. RESULTS: In all dried-blood specimens from each of three patients with CPT-I deficiency, we found an invariably increased ratio of free carnitine to the sum of palmitoylcarnitine and stearoylcarnitine [C0/(C16 + C18)]. The ratio in patients was between 175 and 2000, or 5- to 60-fold higher than the ratio for the 99.9th centile of the normal newborn population in Bavaria (n = 177 842). No overlap with the values of children that were known to be supplemented with carnitine was detected [C0/(C16 + C18), 34 +/- 30; mean +/- SD; n = 27]. CONCLUSIONS: ESI-MS/MS provides a highly specific acylcarnitine profile from dried-blood samples. The ratio of free carnitine to the sum of palmitoylcarnitine and stearoylcarnitine [C0/(C16 + C18)] is highly specific for CPT-I deficiency and may allow presymptomatic diagnosis.     

Sources and control of error in industrial hygiene measurements

Many sources of error exist in industrial hygiene measurements. Errors may be systematic or random. Eliminating or controlling systematic and random error during measurement, analysis, and data interpretation is a matter of aggressive quality control/quality assurance and appropriate statistical treatment of data. The occupational health care professional should be aware of error sources in industrial hygiene measurements and be on the lookout for flawed exposure estimates.     

Automated analysis for free and short-chain acylcarnitine in plasma with a centrifugal analyzer.

We describe a fully automated, spectrophotometric assay of free and total carnitine in plasma ultrafiltrates. The method, suitable for routine application in most hospital laboratories, incorporates the hydrolysis of acylcarnitines to free carnitine within the program of a Cobas Fara II centrifugal analyzer. The hydrolysis is monitored and calibrated with standard solutions containing octanoylcarnitine. Results correlated well with those from a reference isotope-dilution mass spectrometric assay. The ability to analyze a batch of samples for both free and total carnitine within 90 min enables analysis of > or = 100 samples per day. Used in conjunction with acylcarnitine species identification by mass spectrometry, the Cobas assay facilitates the diagnosis of carnitine-deficiency syndromes and specific metabolic disorders.     

Sources of goniometric error at the elbow

We assessed accuracy and potential sources of error in goniometry by using a photographic reference standard. Forty-six physical therapy students measured elbow positions using plastic or steel goniometers following three protocols: ALIGN, in which the investigator's elbow was splinted and bony landmarks were prelabeled; ASSIGN, in which the elbow remained splinted but labels were removed; and PROM, in which raters measured full passive flexion of the elbow. F ratios of variances indicated that alignment of goniometer, identification of landmarks, and variations in manual force during PROM contributed to goniometric error and that accuracy of joint angle measurement by photography (s +/- 0.7-1.1 degrees) was greater than by standard goniometry (s +/- 2.4-3.4 degrees). Analysis of variance and post-hoc test results unexpectedly indicated that all but one goniometric mean differed statistically (p less than .05) from associated photographic means. Small systematic errors in alignment of goniometers and identification of reference landmarks may have accounted for these differences. The results indicate that relatively inexperienced raters should be able to use goniometers accurately to measure elbow position when given standardized methods to follow.     

Determination of free and total carnitine in plasma by an enzymatic reaction and spectrophotometric quantitation spectrophotometric determination of carnitine

OBJECTIVES: Carnitine initiates the beta-oxidation of fatty acids and its deficiency is a problem in several metabolic diseases. This work describes a validated quick and simple enzymatic assay for the determination of free and total carnitine in plasma. METHODS: Carnitine reacts with acetyl-CoA catalized by carnitine acetyltransferase. The coenzyme A liberated combines with 5,5'-dithiobis-(2-nitrobenzoic acid) and forms thiophenolate ion, measured spectrophotometrically at 412 nm. The method requires precipitation of proteins and the alkaline hydrolysis of acylcarnitines for total carnitine. RESULTS: The detection limit is 1.7 micromol/L in plasma and inter- and intra-day imprecision is less than 5%. The recovery of spiked plasma samples is 97%. The method was tested with an inter-laboratory assay, yielding excellent correlation (r(2)=0.994), and it was applied to the determination of normal values of carnitine in plasma. CONCLUSIONS: A reliable spectrophotometric method has been validated with very good precision, with simple instrumental and easy sample preparation.     

Importance of blood-collection tubes in plasma lidocaine determinations.

In 25 clinical samples serum lidocaine concentrations fell from a mean of 6.5 +/- 2.1 mg/L (mean +/- SD) to 4.9 +/- 1.8 mg/L (p less than 0.001) when the blood sample was allowed to make contact with the stopper of the Vacutainer collection tube. In vitro experiments showed that this effect of the stopper occurred only with whole blood and was dependent on sample concentration. The plasma binding of lidocaine decreased from a normal value of 56% +/- 2.2 (mean +/- SD) to 28% +/- 2.2 (p less than 0.001) when exposed to the Vacutainer stopper. We conclude that a chemical leached from such stoppers displaces lidocaine from its plasma-binding sites and that the drug is then redistributed into the erythrocytes, producing spuriously low lidocaine concentrations in plasma or serum. Such artifacts are important in therapeutic drug monitoring and can lead to erroneous clinical decisions.     

Inhibition of mitochondrial carnitine acylcarnitine translocase-mediated uptake of carnitine by 2-(3-methyl-cinnamyl-hydrazono)-propionate. Hydrazonopropionic acids, a new class of hypoglycaemic substances, VI

The rate of mitochondrial carnitine-carnitine exchange mediated by carnitine acylcarnitine translocase was measured by following the uptake of L-[methyl-14C]carnitine. It was demonstrated that the hypoglycaemic compound 2-(3-methyl-cinnamyl-hydrazono)-propionate causes a concentration-dependent decrease in the rate of the translocase-mediated transport of carnitine in guinea pig liver mitochondria. Apparent initial influx rates were decreased by 20% at 0.3 mmol/1 2-(3-methyl-cinnamyl-hydrazono)-propionate, 38% at 0.5 mmol/l, and 75% at 2.0 mmol/l of this compound. This finding may explain the previously observed inhibitory effects of this substance on long-chain fatty acid oxidation, ketone body production and gluconeogenesis.